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1
C O N T E N T S
Ralph deVere White
Director
UC Davis Cancer Center
2
PROFILE
BUILDING
ON BASICS
10 World Wide
Cancer Web
Speeding the exchange of scientific
information to benefit patients
10
FOCUS ON
PAT I E N T S
OUTREACH
12 For Jennifer’s sake
Researchers are pursuing better
ways to fight ovarian cancer
16 Formidable partnership
Teaming up to snuff out ethnic
disparities in cancer
16
B E N E FA C T O R S
22 One in a million
A generous community raises
$1 million for cancer research
NEWS
24 In brief
The 2015 challenge; robotic prostatectomy; healthy Yuba county;
St. Baldrick’s campaign; Hmong
cancer rates; a thousand paper
cranes; immediate breast reconstruction after mastectomy
22
The University of California does not
discriminate on the basis of race, color,
national origin, religion, sex, sexual
orientation, disability, age, veteran’s
status, medical condition, ancestry or
marital status. The University of
California is an affirmative action/
equal opportunity employer. Call
(530) 752-2071 for more information.
Speech or hearing impaired persons may
call (530) 752-7320 (TDD).
6 Lessons in living
A day in the life of an
infusion center
6
José Luis Villegas
Photographer
About the cover:
Using nanotechnology, bits of sugars,
amino acids and polymers can be
combined into new molecules known
as synthetic high-affinity ligands
(SHALs). Researchers at Lawrence
Livermore National Laboratory and
UC Davis Cancer Center are collaborating to create SHALs that will target
cancer cells (see story on page 2).
2 Nano-oncology
Designing nanosize molecules that
detect and infiltrate cancer cells
Pat Grind
Art director
Nora Steiner Mealy
Cory Golden
Mike Martin
Jeff Hudson
Writers
COVER STORY
FIRST STEPS
Claudia Morain
Editor
Wolfe Design Marketing
Graphic design
COVER STORY
FEATURED
CLINICAL TRIAL
29 New strategy for
bladder cancer
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Rod Balhorn
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Designing nanosize molecules that seek out
and infiltrate cancer cells
NANO
oncology
R
Rod Balhorn, a biochemist at
Lawrence Livermore National
Laboratory, has always been
fascinated with biological
molecules and their surfaces.
Their complex, convoluted
structures determine which
other molecules they will
interact with among the thousands they encounter as they
carry out their various functions.
“What if I could design
molecules to interact in ways
that I decide are important?”
Balhorn often wondered. “What
if I could create something that
seeks out, recognizes, and sticks
to the surface of a toxin, for
instance, then destroys it?”
With the help of computer
technology, biochemical manipulations and plain old trial and
error, this sci-fi scenario is
becoming a reality. With his
collaborators at Lawrence
Livermore and UC Davis Cancer
Center, Balhorn has constructed
unimaginably tiny molecules.
He calls them SHALs (for
synthetic high-affinity ligands).
And his novel creations are
beginning to show promise.
W
“What if I
could design
molecules to
interact in
ways that I
decide are
important?”
SHALs have a diameter of
three to four nanometers (a
nanometer is one-billionth of
a meter). A virus, in comparison, is an ungainly 30 to 50
nanometers wide. To put this
infinitesimally small scale in
context, the distance between
two lines of a fingerprint is
about 80,000 nanometers.
SHALs are an example of
nanotechnology, a young field
that may have far-reaching
implications for cancer. SHALs
are among the most exciting
results to emerge so far from the
pioneering partnership between
the UC Davis Cancer Center and
Lawrence Livermore National
Laboratory, in which scientists
are turning biodefense technology into a new cancer offense.
Balhorn originally conceived
of SHALs as a way to thwart
bioterrorism. He wanted to
design molecules to bind to
potential bioterror agents like
botulism or anthrax, in order
to quickly and efficiently detect
and neutralize them.
But it wasn’t long before
the biochemist envisioned
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“Nanotechnology
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is poised to
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enable radical
new approaches
in cancer research
and care.”
medical applications for his
technology. “When I attended
meetings with UC Davis Cancer
Center researchers,” he says,
“I saw the potential of SHALs
to fit their needs.”
Prostate cancer weapon?
One cancer researcher excited
about this potential is HsingJien Kung, deputy director of
the UC Davis Cancer Center
and director of its basic science
program.
Kung’s research focuses on
the androgen receptors on the
surface of prostate cancer cells.
When these receptors are
“activated,” they go into high
gear, resulting in rapid cancer
growth and a poor prognosis
for the patient. But distinguishing
this activated form of the disease
from less aggressive prostate cancer
has always been problematic.
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Enter Balhorn and his SHAL
toolkit. Based on knowledge of
the conformational structure of
the activated receptor, Balhorn
can design a SHAL that will bind
to it. Attached to a fluorescent tag,
the SHAL can lock onto activated
androgen receptors and alert
Kung that they are present in
the prostate cancer cell.
Tiny Trojan horses
The work is still in its initial
phases, but Kung is optimistic
about its potential. “SHALs may
be able to help a clinician predict
whether a cancer needs aggressive therapy before it grows out
of control,” Kung says. “This is
a remarkable technology with
far-reaching applications that no
other current method offers.”
Kung also hopes SHALs may
be used to fight prostate cancer
directly. By competing with the
androgens (male hormones) that
would otherwise bind to activated
receptors, Balhorn’s SHALs may
block the signal for more rapid
cell growth and thereby inhibit
the cancer.
Most cancer treatments
today damage normal as well
as malignant tissue, making
such side effects as hair loss
and nausea all too familiar to
cancer patients undergoing
conventional therapy.
But SHALs, like a Trojan
horse, can be designed to carry
their means of destruction with
them, in the form of a radioactive
isotope or potent anti-cancer drug.
After seeking out and binding to
cancer cells, SHALs can unleash
their weaponry locally, minimizing the risk to normal cells. This
would be a particular boon to
patients with metastatic disease,
in which a cancer has spread
throughout the body.
Gerald and Sally DeNardo,
co-directors of the Radiodiagnosis
and Therapy Program at UC Davis,
are testing radionuclide-toting
SHALs to attack non-Hodgkin’s
lymphoma cells in mice, an
application that may be used in
human clinical trials within the
next few years. If this is successful,
doctors one day may be able to
deliver lethal radiation specifically
to cancer cells, sparing normal
tissue.
Nano-bandwagon
Nanotechnology, which
encompasses minute biologics
and machines on the scale of
nanometers, has the potential to
transform every medical discipline
as well as a host of industries.
Governments and private companies worldwide are jumping on
the nano-bandwagon, investing
around $8.6 billion in 2004.
“Nanotechnology is poised
to enable radical new approaches
in basic cancer research and
clinical cancer care,” says Anna
D. Barker, deputy director for
strategic scientific initiatives
with the National Cancer
Institute, which last summer
earmarked $144.3 million for
nanotechnology research over
the next five years.
Nanotechnology’s diminutive
size gives it such enormous
potential in medicine: nanosize
molecules can cross membranes,
enter cells and interact with
other molecules within and
among cells. “You need to get to
a certain scale to gain access,”
Balhorn says. “Nanotechnology
gives scientists the ability to
actually mimic biologic processes.”
Gerald and Sally DeNardo
are testing radionuclide-toting
SHALs against lymphoma cells
in mice.
How to make a SHAL
To design a SHAL, Balhorn
and his team perform computer
searches of databases that list all
commercially available organic
molecules, including sugars,
amino acids, dyes and detergents – some 300,000 in all –
to find the best match for a target
site. He then combines the
chosen fragments into a single
molecule and mixes this newly
created particle with his target
to see if they bind.
High affinity for the target is
important, not just so the SHAL
can do its job, but also so that it
can outperform other molecules
in the body that may fit the same
target. If necessary, Balhorn can
tinker with a SHAL to enhance
its affinity for a particular target.
For example, he has found that
connecting two of his “best-fit”
molecules with a “linker”
molecule improves its affinity
up to a million-fold.
The synthetic molecules
he creates act just like antibodies
in the immune system, Balhorn
explains. But unlike natural
antibodies, SHALs are often
too small to elicit an immune
response – and therefore aren’t
destroyed by our body’s natural
defenses.
Along with his colleagues in
the new field of nanotechnology,
Balhorn has big dreams for these
tiny tools: He hopes SHALs will
revolutionize how researchers
and clinicians learn about, diagnose and treat cancer and many
other diseases of our time.
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“This is a
remarkable
technology with
far-reaching
applications
that no other
current method
offers.”
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P R O F I L E
A day in the adult infusion center
at UC Davis Cancer Center
Lessons in
living
T
The young Eastern European
woman, her frail frame wrapped
in a bulky blue sweater, shuffles
into the infusion center, gripping her husband’s bent arm for
support. She speaks no English.
Her fear is palpable.
Nurse Ester Molina greets
her and steers her to one of the
19 adult infusion chairs at UC
Davis Cancer Center. Molina
gives the patient a pillow for her
head and blanket for her legs.
Her husband takes a seat at her
side.
Forty-nine people will receive
treatment in the infusion center
today, several for the first time.
But this young woman’s arrival is
cause for quiet excitement among
the infusion staff. Diagnosed
with lymphoma, the frightened
patient has cancelled every
appointment and refused all
treatment, until now.
“If this goes well,” charge
nurse Gale Gibson says at the
morning meeting, “she may
decide to consent to treatment.”
Of the nearly 3,000 new
patients who are seen at UC
Davis Cancer Center each year,
many will pass through the
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“Cancer
patients
don’t sweat
the small
stuff.”
infusion center. Chemotherapy
drugs are administered here, and
blood transfusions are given.
Here patients receive care for
their pumps, ports and PIC lines
– technologies that improve
delivery of anti-cancer drugs
and enable patients to spend
less time at the cancer center.
Patients also learn how to take
medications at home, how to
cope with side effects and when
to call the doctor.
Infusion center nurses are
a special breed, versed in the
latest chemotherapy drugs,
equipped to recognize and
handle allergic reactions and
other medical emergencies, and
skilled at managing such side
effects as nausea and fatigue.
They are also gifted vein-finders,
humorists and listeners.
Over the course of the day
the nurses will carefully review
patients’ lab test results to make
sure each patient is strong
is enough for treatment. If a
patient’s liver function is too
compromised or a blood count
is too low, treatment may be
postponed.
The nurses will check and
double-check the name of each
drug against the name of each
patient, ensuring no one gets
the wrong medication. They
will give patients anti-nausea
medications, timed for optimal
effectiveness, and observe
patients for adverse reactions.
They’ll offer crackers and bring
juice. Between patients, they’ll
disinfect infusion stations,
change pillowcases, fold laundry
and stock supplies.
Sense of humor
Fear may be common here,
but so are laughter, grace and
courage. “When they walk
through the door here for the
first time, a lot of people are just
terrified,” Gibson says. “So we
try to keep it light, keep a sense
of humor. The people who work
here are really good at that.”
At one infusion station,
nurse Marlene Perkins is swapping wisecracks with John
Hauck, a retired trucker. The
West Sacramento man is here
for an infusion of mitoxantrone,
a treatment for prostate cancer.
The chemotherapy solution,
flowing slowly from a bag over
his head to a vein in his arm, is
Popsicle blue. “When you leave
here,” quips Perkins, who has
worked at the cancer center for
more than 30 years, “you’re
going to feel like a giant Smurf.”
A conversation ensues about the
Smurf cartoon show.
Later in the day, Jennifer
Ducray-Morrill, former deputy
treasurer of California, comes
to her appointment bearing gag
gifts for the nurses – yellow
and pink bunny rabbit watches,
finds from a trip to the Dollar
Store. Gibson and Perkins
gather to admire the gifts, but
talk quickly turns to the upcoming wedding of Ducray-Morrill’s
brother. Despite her illness, she
intends to host the reception in
her Land Park home. She thinks
she can make room in the foyer
for dancing.
To keep her colon cancer at
bay, Ducray-Morrill spends four
consecutive days here every other
week. It’s a regimen she may
need to remain on indefinitely.
“I certainly wouldn’t choose
this,” she says. “But the staff
couldn’t be better. They keep
everyone – and themselves –
cheerful. Nobody is ever down.
I don’t know how they do it.
They help you make the best of
a bad situation. And I appreciate
it so much.”
Safe haven
Other patients express similar
sentiments. “I know this sounds
funny,” says Nancy Spain, an
administrative assistant in the
ophthalmology department at
UC Davis Medical Center, “but I
never want to leave here. I don’t
know how to explain it. This is a
safe haven.”
Spain arrived at 8 a.m. and
won’t be released until 1:30 p.m.
For five and a half hours, she
will be tethered to a humming,
beeping pump that will deliver a
fixed rate and volume of taxol, a
breast cancer treatment, into her
bloodstream via the port implanted
in her chest. Yet Spain feels so at
home here, where everyone has
cancer, that she spends the day
with her hat off, bald head bare.
Nurse Anne Beatie checks
in on retired engineer Frank
Tate, a lung cancer patient,
and his wife Pamela.
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Mia Wilson readies
an infusion bag.
Joanie McCreary says
her cancer makes her
appreciate life more –
even the traffic jams.
“They are so great here,” Spain
says. “They hold your hand, all
along this path.”
The admiration is mutual.
“You spend the best time you
can with the patients while
they’re here,” says Robert Araiza,
a nine-year veteran. “And they
show you how to live. A lot of
cancer patients don’t sweat the
small stuff. They focus on what’s
important to them, their friends
and family – and they remind
me that I don’t really have that
many problems.”
Joanie McCreary, a 46-yearold mother of two, arrives for her
infusion armed with knitting, a
portable CD player, earphones
and a book. Her colon cancer
diagnosis last year was a tough
shock, but she says it now
seems like a blessing. Her faith
is stronger than ever, she says,
and she feels grateful for every
day. “I used to complain about
all the traffic in Folsom when
I’d drive my kids around to all
their lessons and activities,” she
says. “Now I like sitting in traffic
because I can sit in traffic.”
Along with gratitude, generosity infuses this center. At the
reception counter is a large
basket with a hand-lettered
sign: “Caps for chemo
“I just take one
step at a time,”
says Nancy
Spain, with
nurse Chris
Sharkey.
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Freshly laundered
blankets are warmed
in an oven before
patients get them.
patients. Please take one.” Volunteers sew and donate the hats.
Next to the hat basket is a candy
jar filled with peppermints.
Nurses keep the jar stocked using
proceeds from the juice cans they
save and recycle.
The gifts from patients to
their nurses are ubiquitous: A
bag of sugar-coated chick peas in
the pantry, a giant tin of Almond
Roca in the lunchroom, plants
and thank you cards everywhere.
Patients also give to each
other: They bring in their magazines, from Harpers and The New
Yorker to Teen People and Star,
hundreds in all. Last year a
Nurse Marlene Perkins
welcomes Donna Reith,
a breast cancer patient.
The day starts with a
7:30 a.m. staff meeting.
Pharmacist Adrienne
Giordano works closely
with infusion nurses.
patient and her husband donated
an ultrasound machine that
makes it easier for nurses to find
veins. One personal DVD player
has been donated to the infusion
center, with eight DVD movies.
The nurses are seeking donations
of 18 more mini DVD players, so
that even when the center is full,
every patient can watch a movie.
By mid-afternoon, five
patients have pushed back their
recliners, footrests up, and are
asleep under their blue blankets.
The lights in two of the infusion
stations have been dimmed. The
patient in station 9 is snoring
softly behind a drawn curtain.
If not for the IV poles and needles,
it might pass for an airplane
cabin on an overnight flight.
The Eastern European woman
has been asleep for most of her
transfusion. Her husband hasn’t
left her side. Molina arrives to
unhook her from the infusion
pump, smile and say goodbye.
The patient walks out, on her
husband’s arm. They both look
relieved. She keeps an appointment with her doctor the following
week, and begins chemotherapy
the week after that.
“It’s a rewarding job,” says
Chris Sharkey, a nurse who has
also worked in hospice, home
health and management settings.
At 3:30 p.m., she finally has time
to fit in a half-hour lunch break.
Infusions are scheduled from
8 a.m. to 4 p.m. Monday through
Friday. Infusion center nurses
work four 10-hour days a week,
from 7:30 a.m. to 6 p.m. each
day, except when a treatment
runs late.
“Sometimes it can be sad,”
Sharkey says, “but we have the
opportunity to help people,
wherever they are in their journey.
And that’s always rewarding.”
At left, John Hauck
and Marlene Perkins
talk Smurfs.
Reading helps pass the time for
the Tates.
At right, nurse Robert Araiza tends
Cynthia Leffler’s PIC line. Leffler
is being treated for breast cancer.
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Ambitious new information grid will translate
into better patient outcomes
WORLD WIDE
Cancer Web
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Cancer research has created an
arsenal of diagnostic, prognostic
and treatment strategies, putting
powerful tools in the hands of
clinicians.
But another mighty weapon
– information – resides in the
laptops, notebooks and minds of
cancer investigators everywhere.
For all of this data to be of real
benefit, it has to be shared.
An ambitious new project
aims to speed both informationsharing and scientific progress.
Known as caBIG – for cancer
Biomedical Informatics Grid –
the project is lauded as the
future of collaborative research.
“Sharing data, methods,
computer programs and reagents
is important in avoiding inefficient
use of resources and in enabling
broad-front research progress,”
says David Rocke, professor of
biostatistics at UC Davis and
one of the architects of caBIG.
A brainchild of the National Cancer Institute and the
cancer research community,
the $20 million caBIG network
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stock bug photo
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Everything
on the grid
will be freely
available to
researchers
and the public.
will enable cancer and biomedical researchers to develop and
share tools and data in an open
environment. Everything on the
grid will be freely available to
researchers and the public worldwide. The goal is to accelerate
progress in all aspects of cancer
research.
The grid will leverage the
combined strengths of the NCI,
its 60 national cancer centers,
including UC Davis Cancer Center,
and others in the cancer research
field. In California, UC Davis is
among five institutions tapped
by the NCI to get the grid off the
ground. Overall nearly 50 organizations are collaborating on the
three-year project.
“UC Davis Cancer Center will
help develop the cutting-edge
communications capabilities that
will be at the forefront of cancer
research nationally,” says Cecil
Lynch, chair of the UC Davis
Medical Informatics graduate
group and an assistant professor
in the UC Davis Department of
Anesthesiology and Pain Man-
“Sharing data is important
in avoiding inefficient use of
resources and enabling broadfront research progress,” David
Rocke says.
agement. Together, Lynch and
Rocke are responsible for the
UC Davis contribution to the
caBIG grid.
Sharing the harvest
In the field of cancer research,
information about cancer –
from genetic and protein studies
to clinical trials – is an abundant
crop.
But cancer researchers may
not always do a good enough
job of sharing this harvest.
“It is currently difficult to
combine and share data, information tools and knowledge in
the cancer-centric and greater
bioinformatics community,” says
Timothy Patrick, associate
director of the National Library
of Medicine’s Biomedical and
Health Informatics Research
Training Program.
Indeed, NCI literature
frequently laments that cancer
researchers work in isolated
“silos.” But if silos are for farms,
not laboratories, why are they so
widespread in science?
“Silos – or islands of data,
information, tools and knowledge
– are difficult to integrate for
both technical and possibly
social reasons,” says Patrick,
who is also a professor of health
management and informatics at
the University of MissouriColumbia School of Medicine.
One technical reason: lack
of common standards. “There
is no systematic method for
general, broad data sharing,”
notes Rocke, who also co-directs
the UC Davis Institute for Data
Analysis and Visualization.
Launched in July 2003,
caBIG aims to change all that by
promoting common standards,
data sharing and team-tested
technologies brought together
in an informatics infrastructure
that NCI director Dr. Andrew
von Eschenbach calls “the
World Wide Web of cancer
research.”
“Any time interoperability,
sharing and combining of
otherwise disparate resources is
made possible, it can certainly
have an effect on the practice of
research,” Patrick says. “The
caBIG project appears to be
addressing these needs.”
(continued on page 21)
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Brian and Jennifer Whitney with
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Researchers are determined to find a screening test for
ovarian cancer, and new treatments for the disease
T
For
Jennifer’s
sake
They call it the disease that
whispers. Ovarian cancer doesn’t
announce itself with obvious
signs. Its early symptoms are so
subtle and nonspecific that twothirds of women with the illness
aren’t diagnosed until they have
advanced disease.
Jennifer Whitney’s experience
was all too typical.
When the Folsom mother of
two began having vague gastrointestinal complaints early last
year, she consulted her primary
care doctor. As her discomfort
worsened, he ordered first a
colonoscopy, then a pelvic
ultrasound.
The colonoscopy was normal.
The ultrasound wasn’t: Both
ovaries appeared grossly enlarged.
Whitney was referred to Gary
Leiserowitz, chief of gynecologic
oncology at UC Davis Cancer
Center. Surgery was scheduled.
The 39-year-old woman wouldn’t
know until afterward whether
she had cancer or a benign problem, such as ovarian cysts.
Whitney’s husband, Brian,
gave her the news in the recovery
room. It was cancer.
T
“Two-thirds
of women
with ovarian
cancer are
diagnosed
with advanced
disease.”
When ovarian cancer is
diagnosed at the earliest stage,
stage 1-A, the five-year diseasefree survival rate is about 90
percent – meaning about nine
in 10 patients will be alive in
five years with no evidence of
disease. Whitney’s cancer, which
had spread to her abdomen, was
stage III-C. For women with this
stage of the illness, the five-year
disease-free survival rate is 25 to
30 percent.
“It’s unacceptable,” Leiserowitz
says, “that a woman could have
such a devastating disease, and we
have no way to find it earlier. It’s
imperative that we find a screening
test for ovarian cancer.”
Says Sidney Scudder, Whitney’s
hematologist-oncologist: “If we
had the same kind of early
detection tools available for
ovarian cancer that we have for
cancers like breast cancer, we
could expect the same survival –
85 to 95 percent at stage I.”
With patients like Whitney
never far from their thoughts,
UC Davis Cancer Center investigators are working hard to
develop such tools – as well as
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Suzanne Miyamoto, in
her lab at UC Davis
Medical Center, works on
a potential screening test
for ovarian cancer.
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new, more effective treatments
for advanced disease.
One potential screening tool
has shown particular promise
in early testing. Cancer center
researchers including Kit Lam,
professor and chief of hematology
and oncology, Suzanne Miyamoto,
a research biochemist, and
Leiserowitz are collaborating
on the project with Carlito
Lebrilla, a professor of chemistry
on the Davis campus.
The investigators have
developed a technique to identify
changes in bloodstream sugars
that appear to be characteristic of
ovarian cancer. The team has
used the technique to test blood
samples from 24 women with
confirmed ovarian cancer and 24
healthy women. “So far it’s been
highly accurate,” Lebrilla says.
The blood test is in preliminary
investigation, but the researchers
are hopeful the approach could
lead to a test that would allow
doctors to detect ovarian cancer
early, when it is most curable.
Women like Whitney – who
faithfully gets her mammogram
and Pap smear every year –
potentially would add one more
test, a blood test for ovarian cancer,
to the annual exam.
There is one commercial
blood test available for ovarian
cancer, but it is too unreliable
for screening. That test, which
measures levels of a tumor marker
known as CA-125, is no more
accurate than a coin toss when it
comes to detecting early ovarian
cancer. CA-125 testing is currently
used for monitoring treatment
response and disease recurrence
in ovarian cancer patients.
Better treatments
Lam is also working on better
treatments for ovarian cancer.
He has discovered one compound
that may double as both a detection method and a treatment for
ovarian cancer. He developed
the compound using combinatorial chemistry, a high-tech
science that allows researchers
to rapidly create and test
potentially therapeutic new
molecules en masse.
In early testing, Lam’s new
compound binds to ovarian
cancer cells but not to any other
cells. He hopes the compound
will be useful for tagging ovarian
cancer cells for diagnosis, or
for delivering drugs directly to
cancer cells.
Several antibody-based
anti-cancer agents, which work
in much the same way, are already
on the market. Examples include
Herceptin, which binds to breast
cancer cells, and Zevalin, which
attaches to lymphoma cells.
Lam’s compound is much
smaller than an antibody, however – and therefore may be
more successful than current
molecularly targeted agents at
penetrating deep inside tumors.
No currently available agent
specifically targets ovarian
cancer cells.
Clinical trials
Meanwhile, five other new
treatment approaches for
ovarian cancer are available
through clinical trials at UC
Davis Cancer Center. Leiserowitz
is the principal investigator of
two of the trials. David Gandara,
professor of hematology and
oncology and the cancer center’s
associate director of clinical
research, heads the others.
These investigational therapies
mean more options for patients
with advanced ovarian cancer
than ever before. Increasingly,
ovarian cancer is becoming a
chronic disease – one that can
be controlled for many years
through a succession of treatments.
Mid-way through her
chemotherapy, wearing a soft
periwinkle cap, Whitney is ready
to get back to her normal activities
– cheering for the boys at
Folsom Junior Bulldogs games,
enjoying the family’s new backyard pool and taking occasional
weekend camping trips.
“I want to be done and move
on with my life,” she says.
Whitney’s doctors want the
same for her – and better
chances for every woman with
ovarian cancer.
I
SS PP RR II N
N G
G // SS U
U M
M M
M EE RR
“It’s imperative
that we find a
screening test
for ovarian
cancer.”
— Gary Leiserowitz
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Dileep G. Bal
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O U T R E A C H
Dileep Bal, who helped make California the nation’s
no-smoking section, is teaming up with UC Davis
Cancer Center to snuff out ethnic disparities in cancer
Formidable
D
partnership
Dileep G. Bal’s three-letter last
name may have become a fourletter word to tobacco and fast
food companies. So be it.
It’s fine by Bal, chief of the
Cancer Control Branch of the
California Department of Health
Services, that he’s been politically
unpopular from time to time.
What does put him on edge,
however, is getting any undue
credit for the state’s leaps forward
in cancer control.
And they have been significant leaps: California adults now
purchase about 45 packs of cigarettes per person per year.
That compares to about 120
packs per person in 1998, when
the state passed Proposition 99,
which added a 25-cent tax to
each pack of cigarettes sold in
California, and remains less than
half the average pack-per-person
rate for the other 49 states
combined.
“The community norm
15 years ago in California was
ubiquitous tobacco use,” Bal
says. “Now, we’ve cut them off
at the pass. Since 1995 you can’t
smoke in restaurants; since 1998
you can’t even smoke in bars.
C
“Collectively
we have had
an impact.”
We have all kinds of occupational health controls; we have
youth-access regulations. We
have all kinds of educational
programs and media programs.
And all that in a political
environment.”
The Cancer Control Branch
is taking the same approach to
combat dietary risk factors for
cancer. “McDonald’s and various
fast-food outlets and producers –
the junk-food producers – they
all peddle their stuff using Madison
Avenue glitz,” Bal says. “And we
do counter-advertising.”
Bal has been given armfuls
of awards for his branch’s
cutting-edge work, a fact he
finds a bit embarrassing. Credit
instead should go to a team
effort that encompasses mainly
his state colleagues, cancer
centers, private organizations
and local public health officials,
he argues. “Collectively,” he
says, “we have had an impact.”
In his own office, Bal preaches
using the “we” word not the
“I” word, and tries to live up
to that principle. “I have no
intention of taking credit for
what this has become, but I had
S P R I N G / S U M M E R
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“We went to
the heart of
the beast. We
demonized
the industry.”
the wisdom to hire some very
good people and to provide
them the resources that were
needed,” he says. “I’ve had the
privilege to work with a group
of very clever people who have
built empires with my assistance, providing funds on
occasion and on occasion
providing them political cover.
Equally important, I’ve stayed
the hell out of their way.”
Public servant
For all his modesty, Bal has
plenty of admirers. Marc Schenker,
professor and chair of public
health sciences at UC Davis,
says Bal “has been instrumental
in advancing public health in
California.”
“His contribution to the
health of Californians is immense,”
Schenker says. “He is a dedicated,
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S Y N T H E S I S
selfless public servant who has
truly made a difference.”
Says Moon S. Chen, Jr.,
professor of public health
sciences and co-leader of the UC
Davis Cancer Center’s Cancer
Prevention and Control Program: “If I had to name a single
individual who was responsible
for making California America’s
no-smoking section, it would be
Dileep Bal.”
But Bal says that what he’s
done, as much as anything, is
give permission for people to
“try crazy things.”
Nowhere has the branch’s
creative approach to motivating
healthier lifestyles shown more
results than in tobacco use in
California. Bal characterizes
the effort as a David vs. Goliath
battle — a state agency going
toe-to-toe with big tobacco,
often on the industry’s own
turf: advertising.
Hitting hard
“We went to the heart of
the beast. We demonized the
industry,” Bal says. “We said,
‘They’re peddling a product
that’s as addictive as cocaine
and heroin and causes nearly
half a million deaths in the
United States every year.’ ”
“They get people hooked
with their predatory marketing
practices … and once they
draw them in with advertising,
they maintain them as customers
because of the addictive nature
of the product. It was a connection
everyone knew but nobody had
countered, so we went to the
‘community norm change model.’
The community norm was
tobacco use, so we hit very hard.”
The Cancer Control Branch
hasn’t stopped there.
“We’re doing some of the
same things with diet. Some
of the people responsible say
comparing fast food to cigarettes
is an overdrawn analogy. I don’t
think so,” Bal says. “They say we’re
acting like the ‘food police’ –
it’s not the food police. We’re
simply trying to move consumers
more towards fruits, vegetables,
trying to keep them away from
alcohol, trying to get them to
exercise more – again, to change
community norms. We’re
countering the predatory
marketing practices that take
primarily low-income people
and get them habituated to fast
food, the wrong food.”
Modern plagues
Changing community norms
is the only way to tackle the
country’s leading killers, like
cancer, coronary heart disease
and obstructive lung disease, Bal
argues. Gone are the days when
health authorities believed top
killers might be foiled solely in
the lab.
“The plagues of today are
all related to today’s lifestyles:
using tobacco, using drugs, using
alcohol, being too fat, being
indolent, not eating the proper
things, not walking up stairs but
taking elevators,” Bal says. “So
the question is: How do we
change the current behavior of
Americans, without doing it in a
way that intrudes into their
personal rights and privileges?”
Trained as a doctor
Bal’s own interest in public
health dates to his early days
as a doctor in his native India.
Bal trained as a physician at the
All India Institute of Medical
Sciences in New Delhi, India,
where he specialized in public
health and preventive medicine.
Practicing afterward in rural
areas, he witnessed the chasm
between health care for the rich
and poor.
When he came to the
United States as a scholarship
student at Columbia in the
late 1960s, Bal again found a
two-tiered health system in
which the poor and uneducated
– more often than not people of
color – didn’t fare as well as the
better-off and educated.
After graduating from
Columbia and later Harvard,
Bal began a career in academia
at the University of Arizona
before opting for a life in public
health. Before taking the helm
of California’s then relatively
small Cancer Control Branch
in 1981, he headed the Pima
County, Ariz., Public Health
Department.
Over the years Bal has also
served as the president of the
American Cancer Society at
both the state and national level,
while continuing to publish
extensively and to serve as the
principal investigator of several
major cancer prevention and
control projects funded by the
National Cancer Institute and
the U.S. Centers for Disease
Control and Prevention.
In addition, he has worked
with UC Davis Cancer Center
leaders to unite and coordinate
the talents of the two institutions in a partnership aimed
at improving the health of all
Californians.
Special relationship
Indeed, the deeply rooted
relationship between UC Davis
Cancer Center and the Cancer
Control Branch of the California
Department of Health Services
has never been closer. The
relationship unites a preeminent
state health department with a
major cancer center, in a concerted
effort to prevent and control
cancer statewide.
For example, Dileep Bal
holds an academic appointment
at UC Davis, as a professor of
public health sciences. He also
serves as the principal investigator
for the Sacramento regional
office of AANCART (Asian
American Network for Cancer
Awareness, Research and Training). This National Cancer Institute-funded project, the largest
ever undertaken to reduce cancer
in Asian Americans, is headquartered at UC Davis. It encompasses investigators at seven
other universities, from the
University of Hawaii to Harvard.
Bal provides regional leadership
as well as support staff and office
space for Sacramento AANCART.
The Cancer Control
Branch and UC Davis recently
co-sponsored the 5th Asian
American Cancer Control
Academy, which drew 450 public
health experts and community
leaders from around the country
to Sacramento. Kurt Snipes,
chief of Cancer Control Planning, Research and Disparities
for DHS, served as academy
superintendent. In addition,
DHS staff provided extensive
administrative support. And
DHS research was prominent at
the academy. Included were
reports on tobacco use, diet and
exercise patterns, and cancer
incidence and mortality among
Asian Americans in California.
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S P R I N G / S U M M E R
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“Do people
get upset?
Sure. Does
it faze us?
No.”
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“Cancer rates in
California, which
were lower than
the rest of the
United States to
start with, are in
an accelerated
decline.”
Through AANCART, UC Davis
Cancer Center and DHS have
worked together to host quarterly cancer education sessions
for Sacramento’s Asian American population, attracting about
125 people to each session.
With AANCART as a model,
UC Davis Cancer Center and
DHS are now developing new
cancer-control initiatives targeted at Sacramento’s African
American, Hispanic and Native
American communities.
“It is personally very rewarding
for me to do on-the-ground work
with UC Davis folks,” Bal says.
Making the effort to change
community norms, however
well meaning, can bring plenty
of heat – especially when it
comes to messing with the like
of big tobacco companies.
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S Y N T H E S I S
“But,” Bal says, “if people
are injuring themselves, it’s
incumbent on us to point out
alternate ways of operating.
That’s what we do.
“Do people get upset? Sure.
Does it faze us? No.”
Success breeds success
Bal says success is the key
to getting things done in a
shifting political landscape.
“When you’ve done things
as controversial as we have,
you have to have successes in
order for people to back off.
In television and radio, you’re
only as good as your last Nielsen
(ratings). Happily, the ratings for
our anti-tobacco ads have been
phenomenal.
“Tobacco use in California has
plummeted. But the proof is in the
pudding – cancer rates in California, which were lower than the rest
of the United States to start with,
are in an accelerated decline.
“We calculate that the net
savings from our plummeting
tobacco use rates is something
like $8 to $10 billion for California.
So we have some capital built up.”
For his part, Bal, 59, says
he plans to retire in four or five
years. He’s not sure just what
he’ll do yet, besides spending
time with his wife, Muktha, and
their children, Sarah and Vijay.
Rest assured, however, that
– ever the team player – Bal
will only be a phone call away.
“If anyone needs me in the
cancer control fight,” he says,
“I’ll be there.”
Ads like these,
produced by
the California
Department of
Health Services,
helped change
attitudes statewide about
smoking, across
ethnic groups.
The ad is available in English
and several
Asian languages.
World Wide Cancer Web
(from page 11)
Cancer research is a big field
comprised of contributions from
molecular biologists, geneticists,
pathologists, zoologists, biologists
and a host of clinical subspecialists.
To be effective, these multidisciplinary researchers must
integrate information from
tumor pathology, genome studies,
proteomics, clinical trials and
digital reams of computerized
analyses.
Then the researchers must
take the most promising ideas
from bench to bedside, and
back to the bench again, for
further refinement.
Streamlined
collaboration
The collaborative thinkers
behind caBIG say this painstaking
work is no job for a closed
system of disparate databases
and creaky communications.
“CaBIG will make cancer
research and cancer care more
efficient and effective,” Rocke
says. “It will help avoid needless
duplication of efforts, and will
assist in keeping cancer research
and treatment more uniformly
state-of-the-art.”
Lynch goes so far as to predict
that caBIG will gradually replace
the traditional system of scientific
sharing through presentation at
scientific meetings and publication
in peer-reviewed scientific journals.
That time-honored system, he says,
makes it difficult for independent
researchers to discover related
projects until late in the process.
In contrast, caBIG will allow
data sharing in near real time.
Grids within grids
The caBIG grid is divided into
smaller grids or “work spaces”
made up of experts in such
areas as clinical trial management, pathology tools and the
language of cancer researchers.
At UC Davis, the NCI saw
research teams capable of helping
to rewrite the protocols of cancer
communications by redefining
and standardizing both language
and practice – a task central to
the grid’s eventual success as an
open and accessible information
“collaboratory.”
“My proposal involved use
of an open-source (freely available)
tool to bridge the gap between
clinical trials adverse events
and hospital lab information
systems,” Lynch says. “This was
precisely the kind of project the
NCI was looking for.”
For UC Davis, involvement in caBIG is a boon to the
university and a benefit to cancer
researchers and the cancer
patients their work aims to heal.
“It is important for UC
Davis Cancer Center to be
included in caBIG – both for
our sake in participating in this
national effort, and for the sake
of caBIG itself,” Rocke says.
This unprecedented endeavor
provides UC Davis with an
opportunity to have input into
the development of caBIG from
the very beginning, Lynch notes.
In addition, a highly visible
project such as caBIG has one
other powerful benefit: as a
beacon that attracts the best
and the brightest.
“It should help translate into
recruitment efforts for fellows
and faculty in both cancer and
informatics research,” Lynch
predicts. “It will also improve
the relationship between the
cancer center and informatics
faculty by laying a foundation
for further work together.”
As its name implies, caBIG is
an ambitious undertaking, without precedent in medical research.
Unprecedented scale
“It is perhaps the largest, bestfunded project of its kind,”
Rocke says. “Other such projects
I am aware of have been grassroots efforts, accomplished without
specific funding. Having the NCI
behind caBIG makes it unique.”
Lynch predicts the grid will
have a big impact on the rate of
discovery of new therapies,
and will provide improved
safety for clinical trial patients
by more rapid reporting and
aggregation of adverse events
related to these therapies.
Size matters in research.
Larger endeavors with the
greatest funding often yield the
most promising results. If caBIG
lives up to its potential, the
giant grid will have a huge
national impact.
S P R I N G / S U M M E R
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B E N E F A C T O R S
A small gold-rush town, with help from neighboring communities,
raises $1 million for cancer research at UC Davis
ONE
in a million
L
Like most communities,
Auburn, Calif., has seen its
share of cancer.
But this Gold Rush-era
town has done something perhaps no other similar-sized city
has accomplished. In a little
less than four years, the small
city has raised a million dollars
for cancer research.
“What made it work was
a just cause and a committed
community,” says Virgil Traynor,
an Auburn veterinarian who
spearheaded the fund-raising
effort with his good friend Dick
Azevedo, an Auburn-based
businessman.
“This is a first,” says Ralph
deVere White, director of the
UC Davis Cancer Center. “The
generous people of Auburn
are a model for how fundraising can become a community
effort. And they have become
great friends.”
Auburn is nestled in the
Sierra foothills about 35 miles
northeast of Sacramento. Once
a mining camp known for bear
fights and public hangings, the
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S Y N T H E S I S
W
“What
made it
work was
just a cause
and a
committed
community.”
town’s Old West origins are still
evident. Every April the community welcomes the Wild West
Stampede, one of California’s
oldest rodeos, and crowns a
new Miss Auburn Stampede.
The town recently dubbed itself
“the endurance capital of the
world,” for its role as host to
some of the world’s toughest
endurance events – the Tevis
Cup Western States Trail Ride,
for example, a 100-mile horse
race from Auburn to Lake Tahoe
through rugged Sierra high
country, and the Western States
Endurance Run/UltraMarathon,
a 100-mile run from Squaw
Valley over Emigrant Pass to
Auburn. About 12,500 people
now live within the city limits,
and about 44,000 in Auburn
and the surrounding area.
The Auburn Community
Cancer Endowment Fund got its
start in April 2001. By August of
that year, $100,000 had been
raised from ten donors.
The other $900,000 came in
more slowly, generated during
three years of barbecues, golf
tournaments, motorcycle rallies
and fun runs, as well as from
continued personal donations.
It took a community with
grit and stamina to raise the
million dollars, but a few
individuals worked especially
hard. Football Hall of Famer
Jim Otto, who moved to Auburn
after retiring from a storied career
with the Oakland Raiders, joined
the effort after he completed
treatment for prostate cancer at
UC Davis Cancer Center.
“The type of cancer I have ...
ten years ago, you died,” Otto
says. “I’m very fortunate, and I
wanted to help.”
Jim and Sally Otto hosted
the first Jim Otto Celebrity
Golf Classic in June 2003 at
the Auburn Valley Golf Club.
Football legends like Fred
Biletnikoff, Willie Brown, Daryle
Lamonica, Otis Sistrunk and
more than two dozen others
participated. The event raised
$150,000. The second tournament last May, featuring another
all-star guest list and also held at
the Auburn Valley Country
Club, raised $200,000.
Besides Otto, other big
names volunteered their help:
the Ladies Professional Golf
Association, Auburn Harley
Davidson, Magnuson Toyota in
Auburn, and the Thunder Valley
Casino, operated by the United
Auburn Indian Community.
More and more individuals
in Auburn and nearby towns
signed on as well. Recruits
included Bart O’Brien, superintendent of the Placer Union
High School District, and Bruce
Dear, Placer County Assessor.
Dear credits Traynor for
keeping the ball rolling. “It’s Virgil’s
energy, rounding the troops
up, providing leadership. That’s
what’s made this a success.”
Cancer touches
everyone
Now that the town has reached
the million-dollar mark, organ-izers have set a new goal: to
raise the total to $1.5 million.
That will fund, in perpetuity,
a faculty chair in basic cancer
research at UC Davis Cancer
Center. Endowed chairs, one of
the highest honors in academia,
allow universities to retain or
recruit the best minds in each
generation.
The endowed chair will be
named in honor of the Auburn
Community Cancer Endowment
Fund. That, too, will be a first.
Other endowed chairs at UC Davis
have been named after individuals
and corporations — but never a
whole community.
As a school administrator,
O’Brien works long hours. But
he made time when Traynor
recruited him. “My mother is a
cancer survivor,” O’Brien says.
“She had surgery 20 years ago,
and she’s 95 now. All our families
have been touched by cancer, and
we can all relate to it.”
Dear’s mother died of cancer
at an early age. He was further
swayed by the range of participants
he encountered at a motorcycle
club benefit for the fund.
“Seeing this long line of
Harley riders, and the tremendous
diversity of the people, and the
idea that they’re all there raising
funds to cure cancer ... That was
a striking moment,” Dear says.
New goal
It takes a village: Members of
the Auburn Community Cancer
Endowment Fund gather at the
Placer County Department of
Museums. Virgil Traynor is
standing in the foreground,
third man from the right.
S P R I N G / S U M M E R
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News in Brief
N ews in Brief
NATION’S TOP CANCER DOCTOR
RENEWS PLEDGE
Andrew C. von Eschenbach, director of the
National Cancer Institute, renewed his pledge to
eliminate the suffering and death due to cancer
by 2015 during a two-day visit to UC Davis
Cancer Center in October.
Andrew C. von
Eschenbach,
director of the
National Cancer
Institute.
The nation’s top cancer doctor delivered
back-to-back keynotes, speaking first at the
cancer center’s annual research symposium on
Oct. 21 and the following morning at the cancer
center-hosted AANCART Academy. AANCART –
for Asian American Network for Cancer Awareness, Research and Training – is an NCI-funded
project that unites investigators from nine cancer
centers in five states in a common effort to reduce
cancer in Asian Americans. UC Davis is national
headquarters for AANCART.
Von Eschenbach first issued his 2015 challenge in the spring of 2003. “We are not saying
that we will ‘cure’ or eliminate all cancer,” he
said. “Rather, we aim to pre-empt the worst
outcomes of the disease: We will prevent more
cancer; we will detect many more cancers
earlier and eliminate them with fewer side
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S Y N T H E S I S
News in Brief
effects; and we will modulate the aggressiveness
of cancer so that people live with, but do not die
from, the disease.”
Von Eschenbach is the 12th director of the
NCI since its creation in 1937.
ROBOTIC-ASSISTED
PROSTATECTOMY
Now there’s “band-aid” surgery for prostate
cancer. The UC Davis Department of Urology
performed eight robotic-assisted laparoscopic
prostatectomies in the first six months after
introducing the procedure last August, giving the
medical center more experience with this new,
minimally invasive prostate cancer surgery than
any other center in the region.
Laparoscopic prostatectomy is performed
via several small incisions, each about the size
of a dime. In a robotic-assisted procedure,
miniature robotic arms and a robotic laparoscope – essentially a tiny telescope – are
introduced through dime-sized incisions in the
abdomen. The surgeon operates the tools from
a nearby console.
Because the procedure involves smaller
incisions, patients may be able to return to their
normal activities more quickly than with standard
prostatectomy. However, urologic oncologists
warn that, as with any surgical procedure, this
one has risks as well as benefits. The procedure
is not appropriate for all prostate cancer patients,
and men who are interested in robotic surgery
should discuss the pros and cons with their
urologists. Men should also choose a surgeon
with extensive training in the new technology.
Of the first eight men to undergo robotic
prostatectomy at UC Davis, all have seen their
prostate-specific antigen (PSA) levels drop to
zero, as would be expected with traditional
prostate removal surgery. PSA levels are a
marker for cancer.
Ne w s i n B r i e f
N e ws in Brief
HEALTHY YUBA COUNTY
A coalition led by UC Davis Health System is
launching a campaign to reduce Yuba County’s
cancer rate, the highest in the state.
Yuba County’s all-cancer mortality rate is the
highest among California’s 58 counties. The
county also ranks 56th in deaths from coronary
heart disease, and 55th in deaths from diabetes.
The Healthy Yuba County project will study
contributing factors to the high rates – tobacco is
a top suspect – and propose programs to reduce
that incidence, according to Bruce Leistikow,
associate professor of public health sciences at
UC Davis School of Medicine and Medical
Center and lead epidemiologist for the project.
Besides UC Davis Health System, the other
founding partners in the Healthy Yuba County
Initiative are the Yuba County Health and Human
Services Department and the Fremont-Rideout
Health Group, based in Yuba City. The three
groups provided start-up funds to collect baseline
data, examine local health-care patterns and
analyze preliminary results. The partners will seek
public and private grants for ongoing funding.
More than a dozen other community organizations will join the effort, including the American Cancer Society, the American Heart Association, Harmony Health, the American Lung
Association, Del Norte Clinic, Peach Tree Clinic,
the Marysville Unified School District, the Beale
Air Force Base public health department, the
Yuba County Tobacco Coalition, the Migrant
Workers Association, the Hmong Association,
the Cancer Surveillance Program, Region 3,
Yuba County for Healthy Children and the Yuba
County Office of Education.
UC Davis Cancer Center and the FremontRideout Health Group are partners in FremontRideout Cancer Center, a comprehensive cancer
treatment center in Marysville. The partnership
enables cancer patients in Yuba and Sutter
counties to receive treatment from UC Davis
Cancer Center specialists without having to
drive to Sacramento.
News in Bri ef
RIPON GIRL LAUNCHES 2005
ST. BALDRICK’S CAMPAIGN
Francesca Arnaudo was 6 when she lost a bone
in her right arm to osteosarcoma. Now 8, the
Ripon third-grader was diagnosed in December
with a second form of cancer, leukemia. One of
the gymnastics enthusiast’s first concerns: that
chemotherapy for her leukemia would cheat her
of the chance to participate in St. Baldrick’s day,
held each March to raise money for childhood
cancer research.
The little girl’s solution: to shave her head
right away, before her sandy blond hair could
fall out due to chemotherapy. Moved by Francesca’s
decision, the New York-based St. Baldrick’s
organization chose the two-time cancer patient
to kick off the organization’s 2005 head-shaving
Francesca
Arnaudo gives
her doctor, Ted
Zwerdling, a
makeover.
campaign in California. The shave took place
at UC Davis Medical Center on Jan. 14. At
Francesca’s request, Ted Zwerdling, her pediatric
oncologist, acted as barber. Afterward, he let
Francesca shave him bald. Dino, Francesca’s
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C A L E N D A R
O F
E V E N T S
March 8
“Supportive Cancer Care—Maximizing Your Quality of Life”
Learn at Lunch Series for cancer patients and survivors
UC Davis Cancer Center auditorium, noon to 1 p.m.
4501 X Street, Sacramento (916) 734-5786
March 17
St. Baldrick’s Celebration & Public Head Shaving
A fund-raiser for pediatric cancer research
Woodcreek Golf Club, 5 p.m. to 9 p.m.
5880 Woodcreek Oaks Boulevard, Roseville (916) 784-6786
March 19
St. Baldrick’s Celebration & Public Head Shaving
A fund-raiser for pediatric cancer research
Empire Club, noon to 6 p.m.
1417 R Street, Sacramento (916) 784-6786
March 29
“The Benefits of Modern Radiation”
Learn at Lunch Series for cancer patients and survivors
UC Davis Cancer Center auditorium, noon to 1 p.m.
4501 X Street, Sacramento (916) 734-5786
Ne ws in B rief
10-year-old brother, let her shave his head
as well.
The St. Baldrick’s head-shaving campaign
has raised nearly $7 million dollars for childhood cancer research since 2000, when three
Irish insurance executives from New York City
conceived the idea to have volunteers in cities
across the country shave their heads in public on
or near St. Patrick’s Day in return for financial
pledges from friends and family.
To make a pledge in Francesca’s name,
contact the Keaton Raphael Memorial at
(916) 784-6786 or info@childcancer.org. The
Keaton Raphael Memorial is a Roseville-based
organization that coordinates St. Baldrick’s
activities in the Sacramento region. The 2005
shave dates are March 17, at the Woodcreek
Golf Course in Roseville, and March 19, at the Empire
Club in Sacramento. For more information, visit
www.childcancer.org or www.stbaldricks.org
NEW LAND, NEW THREAT
April 5
“Popular Diets and Cancer”
Learn at Lunch Series for cancer patients and survivors
UC Davis Cancer Center auditorium, noon to 1 p.m.
4501 X Street, Sacramento (916) 734-5786
April 20
“Managing Cancer Pain and Fatigue”
A community forum sponsored by UC Davis Cancer Center
and the American Cancer Society
UC Davis Cancer Center auditorium, 6 p.m. to 8 p.m.
4501 X Street, Sacramento (916) 734-5786
May 3
“Advance Directives and HIPAA”
Learn at Lunch Series for cancer patients and survivors
UC Davis Cancer Center auditorium, noon to 1 p.m.
4501 X Street, Sacramento (916) 734-5786
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Hmong dancers
performed in
traditional dress
at the Asian
American Cancer
Control Academy.
The Hmong in California face rates of nasopharyngeal, cervical, stomach and liver cancer up
to 16 times higher than those of non-Hispanic
whites and three times higher than those of Asian
Americans overall, according to research presented
at the 5th Asian American Cancer Control Academy
in October. The academy is the annual meeting of
News in Brief
the Asian American Network for Cancer
Awareness, Research and Training (AANCART),
headquartered at UC Davis.
More than a third of the nation’s 169,000
Hmong live in California. In 2003 the U.S. State
Department granted permission for another
15,000 Hmong to enter the country from Thailand. About half of these newest immigrants are
also expected to settle in California.
“This research points to the need for
increased cancer education, awareness and
screening among the Hmong both in California
and nationally to help them confront cancer, one
of their biggest health threats,” said Moon S.
Chen, Jr., professor of public health sciences at
UC Davis School of Medicine and Medical
Center and principal investigator of AANCART.
With the Hmong Women’s Heritage
Association in Sacramento, UC Davis investigators
have translated cancer information pamphlets
into Hmong, compiled a Hmong-English cancer
glossary and taught cancer awareness courses
to Hmong community leaders and medical
interpreters. They’ve also launched a patient
“navigator” program, in which a Hmong medical
interpreter accompanies Hmong cancer patients
to medical appointments. And they are distributing free health kits containing cancer screening and early detection information to new
Hmong immigrants.
The NCI, U.S. Office of Minority Health,
California Department of Health Services and
the American Cancer Society co-sponsored the
AANCART Academy.
ONE THOUSAND PAPER CRANES
“Sadako and the Thousand Cranes” is one of
10-year-old Abby Scurfield’s favorite books. It
tells the story of Sadako, a Japanese girl with
leukemia, who focuses her energy on folding
1,000 paper cranes. Sadako’s determination
made her a national symbol of courage and hope.
Abby, a fifth grader at Leonard DaVinci
Elementary School in Sacramento, decided to
C A L E N D A R
O F
E V E N T S
June 4
National Cancer Survivor’s Day
Richard and Annette Bloch Cancer Survivors Park, 9 a.m.
2601 Stockton Blvd., Sacramento (916) 734-9023
June 7
“Chemo-brain: Chemotherapy-Related Memory and Thinking Changes”
Learn at Lunch Series for cancer patients and survivors
UC Davis Cancer Center auditorium, noon to 1 p.m.
4501 X Street, Sacramento (916) 734-5786
June 28
3rd Annual Jim Otto Swing at Cancer Celebrity Golf Classic
Auburn Valley Country Club
8800 Auburn Valley Road, Auburn (916) 734-9675
August 26
“Chipping Away at Childhood Cancer” Golf Tournament
A Keaton Raphael Memorial fund-raiser for pediatric cancer research
The Ridge Golf Course, Auburn (916) 784-6786
August 27
Celebration Gala
Benefiting research at UC Davis Cancer Center
Hyatt Regency Hotel
Sacramento (916) 418-1667
September 10
Second Saturday — With a Cause
A fund-raiser for leukemia and lymphoma research
The Hen House, 5 p.m. to 9 p.m.
10119 Fair Oaks Blvd., Fair Oaks (916) 984-8000
September 26
“Chipping Away at Childhood Cancer” Golf Tournament
A Keaton Raphael Memorial fund-raiser for pediatric cancer research
Montreux Golf & Country Club
Reno (916) 784-6786
Please check our Web site for calendar updates:
www.ucdmc.ucdavis.edu/cancer
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N ews in Brief
Olivia Bowman,
member of
Junior Girl
Scouts Troop
#1725, displays
one crane.
reenact Sadako’s achievement for the benefit of
children with leukemia and other cancers at UC
Davis Cancer Center. With her friends in
Junior Girl Scouts Troop #1725, Abby folded
a thousand paper cranes that adorned a tree for
pediatric cancer patients at UC Davis Cancer
Center. The girls also asked their friends and
relatives to pledge $1 per crane. The result: a
check for $1,000 to help establish a children’s
cancer resource center at the medical center.
Breast reconstruction
Performing breast reconstruction surgery at the
time of mastectomy does not delay post-operative chemotherapy for women with breast cancer, according to the first study designed to
answer the question. The study appeared in the
September issue of Archives of Surgery.
“At most academic centers that routinely care
for women with breast cancer, immediate breast
reconstruction is the norm for women who opt
for mastectomy,” said Richard Bold, associate
professor of surgical oncology at UC Davis
Cancer Center and senior author of the study.
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News in Brief
“However, a number of our patients come to us
after having been told elsewhere that they
should not have immediate reconstruction
because it delays chemotherapy. We felt it
was an important question to settle.”
Although breast reconstruction can lessen
the impact of mastectomy on a woman’s selfimage and psychosocial wellbeing, some
surgeons – concerned about skin infections
and other wound complications that might
delay chemotherapy – advise women to postpone reconstruction.
In the study, Bold and his colleagues
reviewed the charts of 128 women who
underwent mastectomy at UC Davis Cancer
Center between 1995 and 2002. They found
that while wound complications were more
common with immediate reconstruction, the
complications were too mild – minor skin
infections and small scabs, primarily – to
warrant any delay in starting chemotherapy.
In addition to the potential psychological
benefits of immediate breast reconstruction,
Bold said cosmetic outcomes also tend to be
better with immediate surgery.
Surgical
oncologist
Rick Bold
showed that
immediate breast
reconstruction
does not delay
post-operative
chemotherapy
for women
who undergo a
mastectomy.